简介：Overthepastdecade,percutaneousrenaldenervationhasbeenvigorouslyinvestigatedasatreatmentforresistanthypertension.TheSYMPLICITYradiofrequencycathetersystem(MedtronicCardioVascularInc.,SantaRosa,CA,USA)isthemosttesteddeviceinclinicaltrials.AfterthepositiveresultsofsmallphaseIandIIclinicaltrials,SYMPLICITYHTN-3(aphaseIII,multi-center,blinded,sham-controlledrandomizedclinicaltrial)wascompletedin2014,butdidnotshowsignificantbloodpressureloweringeffectwithrenaldenervationcomparedtomedicaltherapyandcausedtheinvestigatorsandindustrytorevisitboththebasicscienceelementsofrenaldenervationaswellasthedesignofrelatedclinicaltrials.ThisreviewsummarizestheSYMPLICITYtrials,analyzestheSYMPLICITYHTN-3data,andprovidesinsightsgainedfromthistrialinthedesignofthemostrecentclinicaltrial,theSPYRALHTNGlobalclinicaltrial.Otherthanhypertension,theroleofrenaldenervationinthemanagementofotherdiseaseprocessessuchassystolicanddiastolicheartfailure,metabolicsyndrome,arrhythmia,andobstructivesleepapneawiththecommonpathophysiologicpathwayofsympatheticoveractivityisalsodiscussed.

简介：ObjectivesToexploretheeffectoflosartanoncardiacandrenalfunctioninpatientswithchronicheartfailure(CHF).MethodsSixty-fivepatientswithCHFweredividedintotwogroupsusingarandomized,controlandsingleblindmethod:losartangroup(n=30)andconventiongroup(n=35),withatreatmentcourseof8weeksforbothgroups.TheconcentrationsofcystatinC(cysC)inserum,microamountalbumin(MA)inurineweremeasuredbyimmunoturbidimetry.Theconcentrationofaquaporin-2(AQP-2)wasdeterminedbyenzyme-linked-immunosorbentassay(ELISA)andtheheartcontractilefunctionwasmeasuredbyechocardiographybeforeandaftertreatmentrespectively.ResultsComparingwithroutinetreatmentgroup,leftventricularend-diastolicdimension(LVEDd)decreasedsignificantly,whileleftventricularejectionfraction(LVEF)andleftventricularfractionalshortening(LVFS)increasedsignificantlyinlosartangroup.ThelevelsofcysCinserumandMA,AQP-2inurineweresignificantlylowerinlosartangroupthaninroutinetreatmentgroup.ConclusionLosartancanimprovecardiacandrenalfunctioninpatientswithCHF.

简介：ObjectivesTostudythechangesofnitricoxide,angiotensinⅡandsuperoxideanioninrenalarteryhypertensionpathogenesis.MethodsMaleWistarratsweighing256-285gweredividedinto5groupsrandomly,10ratsofeachgroup.Controlgroup:falseoperationwasmadeandroutinedietwasgiven;Ligaturegroup:leftrenalarterywasligatureduncompletelyandroutinedietwasgiven;Ligature+Losartangroup:leftrenalarterywasligatureduncompletelyandLosartan20mg·kg^-1·d^-1wasaddedinthedrinkingwater;Ligature+L-Arggroup:leftrenalarterywasligatureduncompletelyandL-Arg2g·kg^-1·d^-1wasaddedinthedrinkingwater;Ligature+L-Arg+Losartangroup:leftrenalarterywasligatureduncompletelyandL-Arg2g·kg^-1·d^-1andLosartan20mg·kg^-1·d^-1wasaddedinthedrinkingwater.Bloodpressureandheartrateweremeasuredbeforeandattheendoftheexperiment.Oneweekafterligature,bloodwasdrawntodetermineangiotensinⅡ,cGMP,nitricoxide,nitricoxidesynthase(NOS),O2^-,superoxidedismutase(SOD).ResultsSystolicbloodpressurewashigherinligaturegroupthanthatincontrolgroup(p<0.05),systolicbloodpressurewasmuchlowerinligature+Losartangroupthanthatinligaturegroup.Heartratedidnotchangesignificantlyafterexperiment(p>0.05).AngⅡwashigherinligaturegroupthanthatincontrolgroup,evenmuchhigherinligature+Losartangroup(p<0.01).TherewasnodifferenceofcGMPineachgroup(p>0.05).TheconcentrationofNOwaslowerinligaturegroup(p<0.05),NOwashigherinligature+L-Arg+Losartangroupthanthatinligaturegroup(p<0.05).O2^-washigherinligaturegroupandligature+L-Arggroupthanthatincontrolgroup(p<0.05),O2^-waslowerinligature+Losartangroupthanthatinligaturegroup(p<0.05).ThelevelofSODwaslowerinligaturegroupthanthatincontrolgroup(p<0.05),higherinligature+L-Arggroupandligature+L-Arg+Losartangroupthanthatinligature

简介：Thisstudyinvestigatedtheeffectofcatheter-basedrenalsympatheticdenervation(RD)onleftventricularhypertrophy(LVH)andsystolicanddiastolicfunctioninpatientswithresistanthypertension.LVHanddiastolicdysfunctionareassociatedwithelevatedsympatheticactivityandincreasedmorbidityandmortality.TheeffectofRDonLVHandLVfunctionisunclear.MethodsandResultsForty-sixpatientsunderwentbilateralRD,and18patientsservedascontrols.Transthoracicechocardiographywasperformedatbaseline,andafter1monthand6months.Besidesreductionofsystolicanddiastolicbloodpressure(-22.5/-7.2mmHgat1monthand-27.8/-8.8mmHgat6months,P<0.001ateachtimepoint),RDsignificantlyreducedmeaninterventricularseptumthicknessfrom14.1±1.9mmto13.4±2.1mmand12.5±1.4mm(P=0.007),andLVmassindexfrom53.9±15.6g/m(2.7)(112.4±33.9g/m(2))to47.0±14.2g/m(2.7)(103.6±30.5g/m(2))and44.7±14.9g/m(2.7)(94.9±29.8g/m(2))(P<0.001)at1monthand6months,respectively.ThemitralvalvelateralE/E'decreasedafterRDfrom9.9±4.0to7.9±2.2at1monthand7.4±2.7at6months(P<0.001),indicatingreductionofLVfillingpressures.Isovolumicrelaxationtimeshortened(baseline109.1±21.7msvs.85.6±24.4msat6months,P=0.006),whereasejectionfractionsignificantlyincreasedafterRD(baseline:63.1±8.1%vs.70.1±11.5%at6months,P<0.001).Nosignificantchangeswereobtainedincontrolpatients.ConslusionsBesidestheknowneffectonbloodpressure,ourstudyshowedforthefirsttimethatRDsignificantlyreducesLVmassandimprovesdiastolicfunction,whichmighthaveimportantprognosticimplicationsinpatientswithresistanthypertensionathighcardiovascularrisk.

简介：BackgroundPatientswithunstableanginapectorisanddiabetesmellitusareverycommon.Whentheyreceiveinterventionaltherapy,contrastagentscancauserenalinjuryandplateletactivation.Alprostadilhasbeenshowntodecreaseinflammationandmicrovascularresistance.Thereisnoanyreportontheprotectioneffectsofalprostadilonrenalinjuryandtheplateletactivationduringcardiacinterventionaltherapy.MethodsAtotalof57patientsweredividedintotwogroups,alprostadilgroup(n=35)andnormalgroupn=22).BUN(bloodureanitrogen)andSCr(serumcreatine)weremeasuredastherenalfunctionparameters.GFR(glomerularfiltrationrate)wascalculatedbytheMDRDformula.Plateletparameters:PLT(plateletcount,109),PDW(plateletdistributionwidth,fL),MPV(meanplateletvolume,fL),PLCR(largeplateletscaleratio,%)weremeasuredastheplateletactivationindex.TtestandChi-squaretestwereusedasstatisticalmethods,andP<0.05wasconsideredstatisticallysignificant.ResultsInthealprostadilgroup,SCrwas71.1±13.8μmol/Land65.9±12.6μmol/L,beforeandafterinterventionaltherapy(P<0.05).BUNwas5.68±1.79mmol/Land3.86±1.19mmol/L(P<0.001),beforeandafterinterventionaltherapy.Intheplatelettests,MPVwasseemedtobetheonlyusefulplateletparameter,beforeandafterinterventionaltherapy(11.8±1.8fLand11.1±1.2fL,P<0.05),whilethePLT(109/L),PDW(fl),PLCR(%)didn'tshowanysignificantdifference.Inthenormalgroup,allthesetests'resultsdidn'tsignificantlychangeafterinterventionaltherapy.ConclusionsThepatientswiththeunstableanginapectorisanddiabetesmellitushaveontheriskofrenalfunctiondamageandplateletactivationwhenundertakingcardiacinterventionaltherapy.Alprostadilprotectsrenalfunctionandalleviatesplateletactivation.